Barriers Steer Minority Med Students Away From Dermatology

Minority medical students perceived a number of factors as deterring them from pursuing careers in dermatology, according to survey results.

One was the current lack of diversity in dermatology, according to Yssra Soliman, BA, of Albert Einstein College of Medicine in Bronx, New York, and colleagues in JAMA Dermatology. They noted that African-Americans and Hispanics each make up less than 5% of practicing dermatologists, far less than their proportions in the general population.

When Soliman and colleagues asked medical students to quantify potential barriers on a five-point Likert scale, the field’s current overwhelming whiteness (expressed as “lack of evident diversity” in the survey) averaged 4.50 among members of Hispanic, Spanish, and Latino ethnic minority groups, 4.13 among African-Americans, and 4.41 among students with incomes of $20,000 to $40,000 annually.

Other barriers receiving high scores, indicating strong inhibition, included poor access to mentors and networking opportunities, clinical grades, the U.S. Medical Licensing Examination Step 1, socioeconomic barriers (such as student debt forgiveness), risks of not matching in the residency selection process, and “perceived exclusivity of the field.”

The least important barrier for most groups, was “negative perceptions of minority students by residency programs.” On the other hand, Likert scores averaged above 3 in nearly every group.

“When you practice in a diverse setting, there’s greater cultural competency and just like much better medical care provided to your communities,” Soliman told MedPage Today. “So I think it is in the best interest of these academic physicians to want to train students of all different backgrounds to pursue a career not just in dermatology, but really in all these competitive fields that truly lack diversity. That means going out of their way to mentor these students whether it’s by incorporating dermatology into the medical curriculum in the pre-clinical years, which doesn’t happen at most medical schools.”

In their research letter, the group noted that patients tend to have longer visits and come away more satisfied when their doctors have the same race/ethnicity as themselves. Hence, proportional minority representation among clinicians benefits patient care. Recent efforts have emphasized the need for evidence-based research to better understand barriers preventing minority students from pursuing careers in dermatology, the investigators said.

The barriers highlighted in this paper “differ by the racial, ethnic, and socioeconomic backgrounds of students and highlight the need to actively recruit and mentor students of all backgrounds,” the researchers emphasized.

Moreover, “efforts should be made to increase minority students’ exposure to dermatology by incorporating it into the curriculum, providing research opportunities, and reducing the cost of ‘visiting electives’ by providing stipends,” the study authors wrote.

Survey details

Respondents included 155 medical students at 28 medical schools. Self-reported racial/ethnic makeup was as follows:

• 15.5% African American
• 27.1% Asian
• 41.9% white
• 3.9% multi-race
• 7.1% Middle Eastern and/or North African
• 3.9% other

For annual household income when growing up, 11.0% of participants reported $20,000 to $40,000 and 5.8% indicated less than $20,000.

Overall, 43.2% of participants said they considered applying for a dermatology residency program.

The investigators acknowledged the limitations of their work as the survey respondents might not represent all medical students. “The other limitation is I think there is definitely a difference between certain minorities in medicine, some are underrepresented and overrepresented,” Soliman emphasized.

“Historically, Asian minorities are overrepresented in medicine. Just by the nature of the people who took the survey, a lot of our Asian participants cited that they were born outside of the United States or they actually spoke a first language other than English. So for the nature of this population, we decided to include them as minorities, so that could also be seen as a limitation of this study,” she said.

Also, the survey focused on dermatology and did not ask respondents about their perceptions of other specialties. Thus, it remains unclear whether minority medical students find dermatology unusually daunting.